Reproductive health among Finnish women with schizophrenia or schizoaffective disorder

During the 19th century and beginning of the 20th century the concept of eugenic ideology raised its head. In Finland the law for forced sterilization was accepted in 1934 and government-funded sterilization program took place all over the country. Between the years 1935-1970, approximately 7500 people, mostly women were sterilized according to current sterilization law (Hietala, 2009). Almost half of the sterilized individuals suffered from intellectual disability, but there were also persons with schizophrenia. The position and role of women with schizophrenia and schizoaffective disorder has improved since the times described above, but the road has not been easy. However, both the ongoing de-institutialization, as well as the use of modern antipsychotic medications with less endocrine side-effects has led to an increase in relative fertility and pregnancies of the women with schizophrenia. The purpose of this nationally representative follow-up study was to assess induced abortions and pregnancy-related and delivery-related health outcomes of women with schizophrenia or schizoaffective disorder, as well as to investigate negative perinatal health outcomes and out-of-home placements of their offspring. Using the Care Register for Health Care, Finnish women, born between the years 1965 and 1980 and diagnosed with schizophrenia or schizoaffective disorder were identified during the follow-up period ending 31.12.2013 (n= 5214). For each case, five age- and place of birth-matched controls were obtained from the population Register (n= 25,999). The Medical Birth Register, the Induced Abortion Register, the Register of Congenital Malformations and the Child Welfare Register were used to gather information about mothers and their offspring. The incidence of induced abortions in women with schizophrenia or schizoaffective disorder is similar to that of population controls, but their risk per pregnancy was over two-fold. Women with schizophrenia or schizoaffective disorder were significantly older and more often single at the beginning of the pregnancy. Their body mass index (BMI) before pregnancy was significantly higher and they smoked significantly more often both in the beginning of the pregnancy and after the first trimester. During pregnancy, the risk of pathologic oral glucose test, initiation of insulin, fast fetal growth, premature contractions and hypertension was significantly higher among affected women. Focusing on obstetric complications, the risk of induction of labor, delivery by cesarean section and delivery by elective cesarean section was significantly higher among affected women. The risk of premature birth, low birth weight, low Apgar score at 1 minute, and having a major congenital anomaly to name a few was significantly increased among babies with a mother suffering from schizophrenia or schizoaffective disorder. Children with an affected mother were placed out of home significantly more often than those with a non-affected mother. Among affected mothers, single motherhood and smoking in the beginning of pregnancy but not unwanted perinatal health outcomes of the child increased the risk of out-of-home placement. Schizophrenia and schizoaffective disorder are associated with some risk factors related to pregnancy, as well as with some pregnancy- and delivery-related complications. Maternal schizophrenia and schizoaffective disorder associate with some negative perinatal health outcomes, as well as with out-of-home placements of the offspring. Family planning services